folate, folic acid, folinic acid, methylfolate

Folate, Folic acid, Folinic acid, Methylfolate – Whats the difference?

A common question I receive in clinical practice is about folic acid supplementation. What type of folate is best? How much should I take? Why should I take it?

Folate is the natural form of vitamin B9 that is plentiful in dark green leafy vegetables, legumes, and cruciferous vegetables like broccoli. It is essential for DNA production, correct cell division, activating B12, reducing homocysteine levels and supporting the synthesis of SAMe for healthy mood and joints. In pregnancy, folate and other B vitamins help to reduce the risk of spinal bifida.

Folic acid is the synthetic form of folate that is often in supplements and in fortified foods such as cereals.

There is a gene, called MTHFR, that helps produce an enzyme that converts a portion of folate and folic acid into folinic acid. Folinic acid is then converted into the active form methylfolate, which is used by our cells to perform the functions mentioned above.

For those with normal MTHFR gene variants, 500mcg of folic acid is recommended to reduce the risk of spinal bifida in a growing foetus. However, if an individual has a MTHFR gene mutation, then dietary folate and folic acid supplements may not be converted to the active forms such as folinic acid and methylfolate sufficiently, which can increase the risk of birth defects, miscarriage, increased homocysteine levels and clotting.

There is debate about what form of folate should be taken in individuals with more serious MTHFR gene mutations. It is generally agreed upon that folinic acid or methylfolate (activated folates) supplementation is more suitable for those with MTHFR gene mutations as these forms have already undergone metabolism. For those with normal MTHFR gene variations, then folic acid is still suitable.

For further information about which folate to supplement, speak to a healthcare professional who is familiar with folate metabolism and MTHFR genes. This article does not constitute health advice, always speak to your registered healthcare professional before supplementing.

References

Braun L, Cohen M. Herbs and natural supplements: an evidence-based guide, 3rd ed. Sydney: Churchill Livingstone Elsevier, 2010.

https://www.mthfrsupport.com.au/what-is-mthfr/

Kim YI. Folic acid fortification and supplementation–good for some but not so good for others. Nutr Rev 2007;65(11):504-511

Scaglione F, et al. Folate, folic acid and 5-methyltetrahydrofolate are not the same thing. Xenobiotica. 2014 May;44(5):480-8

https://www.ncbi.nlm.nih.gov/pubmed/24494987

R Prinz-Langenohl, et al. [6S]-5-methyltetrahydrofolate increases plasma folate more effectively than folic acid in women with the homozygous or wild-type 677C→T polymorphism of methylenetetrahydrofolate reductaseBr J Pharmacol. 2009 Dec; 158(8): 2014–2021

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807663/